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Reactive Attachment Disorder Assessment and Treatment

Andrea Barkoukis, M.A., Natalie Staats Reiss, Ph.D., and Mark Dombeck, Ph.D.

Assessment of Reactive Attachment Disorder

Currently, there is no specific, validated tool for diagnosing Reactive Attachment Disorder. Diagnosis is made on the basis of a diagnostic interview, history and behavioral observation. Medical and psychiatric examinations of symptomatic children are appropriate so as to rule out physical causes or differential mental illness diagnoses which might account for children's withdrawal, ambivalence or social promiscuity. For instance, the diagnosis of Social Phobia should be ruled out before a diagnosis of Reactive Attachment Disorder is finalized. Both Social Phobia and Reactive Attachment Disorder might present with social withdrawal as a primary symptom. However, Social Phobia involves intense anxiety in social settings apart from core family interactions. In Reactive Attachment Disorder, all interpersonal relationships are disturbed.

Treatment of Reactive Attachment Disorder

mother and son talkingLoving and capable caregivers provide the core of what is needed to help children with a Reactive Attachment Disorder begin their recovery. It is not necessary that the family be especially wealthy so long as they can meet their child's basic needs. It is also not necessary that the family be biologically related to the child, although it is nice if this can occur. Children do not need to be taken away from previously abusive or neglectful parents if it can be established that those parents are reformed sufficiently to become loving and competent caregivers. What is necessary for affected children to recover is that they are no longer neglected or abused, and are instead offered plentiful opportunities for loving interaction.

Merely being in the presence of a loving family may not be enough to help some children with more severe Reactive Attachment Disorders. Such children may persist in their inhibited or disinhibited behavior despite their family's best efforts. In such cases, professional treatment is necessary. There is no singularly useful therapy for helping Reactive Attachment Disordered children recover. Instead, a combination of therapy approaches may be recommended.

Psychoeducational approaches, which consist of teaching family members (adult and children alike) about the nature of the disorder they are facing offer a good start. Educational approaches help family members to put their fears and concerns into context and develop a realistic understanding of what it will take for their child to trust others and form intimate relationships again.

It may be recommended that all family members participate in family therapy. Family therapists understand the many different ways that individual problems can affect family members as a whole, and they use this knowledge to help family members understand how to best relate to one another to promote overall family harmony. For instance, a family therapist who observes that parents are frustrated with one another because of the difficulties they face raising a child with Reactive Attachment Disorder can help these parents to see what is happening and how they can correct their own behavior before it makes their larger family situation more difficult. All children who observe parental fighting are likely to become frightened, not just children with Reactive Attachment Disorder.

Parents may also be referred for parenting skills classes. Technically a form of psychoeducation, parenting skills classes present useful caregiving skills (such as effective discipline strategies that do not involve punishment or yelling) in a lecture format so that they feel more like a class and less like therapy.

Parents may also be referred to a behavior therapist who can help them set up a behavior plan within the household to promote their child's interaction with other family members (in the case of ambivalent, inhibited children) and/or to discourage interactions with strangers (in the case of disinhibited children).

Reactive Attachment Disordered children themselves may be recommended to work with child-oriented cognitive behavioral or play therapists, in order to help them express and process complicated feelings they may have about their previous abuse, and to develop more effective ways of coping with those feelings that do not preclude the possibility of intimacy. The development of a healthy relationship with a therapist will likely be beneficial in your child's course of treatment.

These various possible treatments for a child's Reactive Attachment Disorder focus on enhancing the child's appropriate attachment relationships, discouraging inappropriate/unsafe attachment behavior, helping to promote harmonious relationships within the family as a whole, and increasing the child's available social supports. The goal of these interventions is to encourage the child to develop trust in the possibility of consistent loving and safe relationships; an outcome that vastly increases their ability to develop appropriate peer and romantic relationships and to participate in the adult social world they will one day inhabit.